Part B News Features
Question: I have a patient who claims “white coat hypertension” — that is, he says his home blood pressure readings are significantly lower than the ones we get in the office. He has... More
Recent changes mandated by Congress and CMS that boost the status of physician assistants (PA) — or physician associates, as some groups prefer — is another sign that the providers formerl... More
Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service)... More
Question: I have a patient who claims “white coat hypertension” — that is, he says his home blood pressure readings are significantly lower than the ones we get in the office. He has... More
Recent changes mandated by Congress and CMS that boost the status of physician assistants (PA) — or physician associates, as some groups prefer — is another sign that the providers formerl... More
Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service)... More
Tools
Prepare members of your treatment and coding teams for changes to the diagnosis code set that will go into effect Oct. 1, 2024. Download and share the Excel file that contains five spreadsheets.
Make sure your physicians and qualified health care professionals (QHP) are ready for their crucial role in reporting G0136 (Administration of a standardized, evidence-based Social Determinants of Health [SDOH] Risk Assessment tool, 5-15 minutes, not more often than every 6 months).
Benchmark of the Week
Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) continues to see high utilization. Providers reported it on more than 65 million claims in 2023.
The projected share of individuals under Medicare coverage will grow substantially over the next decade, accruing approximately 23% growth between 2024 and 2034. The Medicare surge is projected to happen while employer-sponsored plans also grow, but Medicaid numbers take a big hit.

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